Coronary artery surgery in a patient with grossly emphysematous lung

Abstract

The pedicled left internal thoracic artery graft is the mandatory conduit in coronary artery bypass surgery. A grossly emphysematous lung may sometimes present a significant problem for positioning of the pedicled left internal thoracic artery conduit. An inverted pedicled left internal thoracic artery graft (internal thoracic artery transected near its origin, thus supplied by retrograde flow from superior epigastric and musculophrenic arteries) might occasionally be the conduit of choice for those patients.

Mid‐Term Patency of the Inverted Left Internal Thoracic Artery Conduit

“…All four patients (males, mean age 67.5 ± 5.8 years) presented with moderately impaired left ventricular function and triple vessel disease, including severely stenosed or occluded LADs. This included one case of an accidental damage of the proximal LITA during harvesting, as well as one case where we intentionally divided the LITA near its origin to avoid compressions of the LITA in a patient with grossly emphysematous lung . Since hemodynamically significant flow steal and consequent myocardial ischemia have been reported during hemodialysis in patients with an upper extremity arteriovenous fistula when the ipsilateral ITA is used to bypass coronary arteries, we used the reversed LITA in our third patient on chronic hemodialysis.…”

“…mean flow from the inverted LITA conduits was 85.0 AE 14.7 mL/min (range, 70 to 105 mL/min). The 64-slice multidetector row computed tomographic (MDCT) scans performed postoperatively (range, 6 to 40 days) demonstrated all inverted LITA conduits with thrombolysis in myocardial infarction (TIMI) 3 flow,5 supplied by retrograde flow from the superior epigastric and musculophrenic arteries [1][2][3]. Follow-up MDCT scans were performed in all patients at a mean period of 25.5 AE 7.3 months (range, 18 to 35 months) after surgery, and TIMI 3 flow of all inverted LITA conduits was confirmed (Figs.…”

Reply to the Editor

“…Previously, impairment of RV performance after cardiothoracic surgery with cardiopulmonary bypass has been described in several other subgroups of patients with congenital heart defects. 5 In these studies, cardiopulmonary bypass was suggested have an important detrimental effect on both short-and medium-term postoperative RV performance values after cardiothoracic surgery in children. 5 In our study, 1 we could not elucidate the exact mechanism of the deterioration of RV performance.…”

“…5 In these studies, cardiopulmonary bypass was suggested have an important detrimental effect on both short-and medium-term postoperative RV performance values after cardiothoracic surgery in children. 5 In our study, 1 we could not elucidate the exact mechanism of the deterioration of RV performance. As suggested by Koestenberger and colleagues, however, we hope that our findings encourage future research and routine follow-up of RV performance after correction of congenital heart defects.…”

“…Furthermore, all RV performance parameters remained impaired in patients relative to control subjects 9 months postoperatively. For the convenience of Journal readers, we would like to mention that a comparison of their TAPSE and S 0 data with available TAPSE and S 0 normal values and z scores 4,5 would have improved the statistical power of their analysis.…”